Hugo Bonatti, MD. University of Maryland Community Medical Group Surgical Care
Background: The majority of surgeons use four ports including for laparoscopic cholecystectomy (LC). Multiple efforts have been made to reduce number and size of ports. left upper quadrant (LUQ).
Patients and methods: Of 127 LCs performed from 6/2013 – 9/2016, 115 (91%) were done using three instruments including 46 cases in which 2 trocars and a needle grasper were used. A 5mm trocar was placed in the left upper quadrant (LUQ) and a 10-12 mm trocar (n=25) or 5mm trocar (n=21) into the umbilicus. The Teleflex minigrasper was placed between the two trocars. The gallbladder (GB) serosa was incised on both sides and a window was created behind the GB midportion and widened towards fundus and infundibulum. Cystic artery (CA) and cystic duct (CD) were dissected out obtaining the critical view and after the last fundus adhesion was cut, CA and CD were secured with clips or endoloop.
Results: Median age of 36 women and 10 men was 44.1 (range 23.2-77.4) years. LC was done for acute cholecystitis (n=12), chronic cholecystitis (n=25), other (n=9). In 41 cases the procedure was done in the modified dome down technique. Additional procedures were done in 20 patients including liver wedge biopsy (n=5), lysis of adhesions (n=10) others (n=5). Median operative time was 46 minutes with a range of 27 to 120 minutes. There were no vascular or bile duct injuries in this series. 54% of cases were done as outpatient procedures, 34% of patients required 23hours observation and 11% were hospitalized.
Conclusions: Three instrument modified dome down technique with trocar placement in LUQ is feasible in the majority of cases. The Teleflex minigrasper can replace a port. In selected cases with small stones or biliary dyskinesia, LC with only two 5mm ports and a needle grasper is possible. This approach is associated with high patient satisfaction and excellent cosmetic result.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80736
Program Number: P124
Presentation Session: Poster (Non CME)
Presentation Type: Poster